{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:06:45Z","timestamp":1779527205514,"version":"3.53.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n MR-guided focused ultrasound (MRgFUS) thalamotomy is an incisionless neurosurgical treatment for patients with medically refractory essential tremor and tremor-dominant Parkinson\u2019s disease. A low skull density ratio (SDR) < 0.40 is a known risk factor for treatment failure. The aim of this study was to identify useful sonication strategies for patients with a low SDR < 0.40 by modifying the standard sonication protocol using maximum high-energy sonication while minimizing the number of sonications.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively analyzed the effects of modified MRgFUS sonication on low-SDR tremor patients. All patients underwent head CT scans to calculate their SDR. The SDR threshold for MRgFUS thalamotomy was 0.35. The patients in the early series underwent the standard sonication protocol targeting the ventral intermediate nucleus contralateral to the treated hand side. The patients with a low SDR < 0.40 in the late series underwent a modified sonication protocol, in which the number of alignment sonications was minimized and high-energy treatment sonication (> 36,000 J) was used. The authors evaluated the lesion volume the following day and tremor improvement and adverse events 3 and 12 months after the procedure. The sonication patterns between low-SDR patients treated using different sonication protocols were examined using Fisher\u2019s exact test. ANOVA was used to examine the lesion volume and tremor improvement in high- and low-SDR patients treated using different sonication protocols.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among 41 patients with an SDR < 0.40, 14 underwent standard sonication and 27 underwent modified sonication. Fewer alignment sonications and high-energy treatment sonications were used in the modified sonication group compared with the standard group (p < 0.001). The duration of modified sonication was significantly shorter than that of standard sonication (p < 0.001). The lesion volume and tremor improvement significantly differed among the high- and low-SDR groups with different sonication protocols (p < 0.001). Low-SDR patients treated using modified sonication protocols had comparable lesion volume and tremor improvement to the high-SDR group. The modified sonication protocol did not significantly increase adverse intraprocedural and postprocedural events.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Minimizing alignment sonications and applying high-energy sonication in early treatment help to create an optimal lesion volume and control tremor in low-SDR patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.6.focus24330","type":"journal-article","created":{"date-parts":[[2024,9,1]],"date-time":"2024-09-01T09:09:09Z","timestamp":1725181749000},"page":"E4","source":"Crossref","is-referenced-by-count":9,"title":["Minimum and early high-energy sonication protocol of MR-guided focused ultrasound thalamotomy for low\u2013skull density ratio patients with essential tremor and Parkinson\u2019s disease"],"prefix":"10.3171","volume":"57","author":[{"given":"Namiko","family":"Nishida","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshito","family":"Sugita","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Sawada","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Ishimori","sequence":"additional","affiliation":[{"name":"Diagnostic Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Taruno","sequence":"additional","affiliation":[{"name":"Neurology, Medical Research Institute Kitano Hospital, Osaka; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Motoie","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushi","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Yoshizaki","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Kasashima","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumpei","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahito","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Hanyu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makio","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Neurology, Medical Research Institute Kitano Hospital, Osaka; and"},{"name":"Department of Neurodegenerative Disorders, Kansai Medical University, Hirakata, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Neurology, Medical Research Institute Kitano Hospital, Osaka; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Toda","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"B1","series-title":"N Engl J Med","first-page":"730","article-title":"A randomized trial of focused ultrasound thalamotomy for essential tremor","volume":"375","author":"Elias WJ","year":"2016","unstructured":"Elias WJ, Lipsman N, Ondo WG, A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016;375(8):730\u2013739."},{"issue":"12","key":"B2","series-title":"JAMA Neurol","first-page":"1412","article-title":"Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial","volume":"74","author":"Bond AE","year":"2017","unstructured":"Bond AE, Shah BB, Huss DS, Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017;74(12):1412\u20131418."},{"issue":"11","key":"B3","series-title":"Med Phys","first-page":"112901","article-title":"Integrated ultrasound and magnetic resonance imaging for simultaneous temperature and cavitation monitoring during focused ultrasound therapies","volume":"40","author":"Arvanitis CD","year":"2013","unstructured":"Arvanitis CD, McDannold N. 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J Neurosurg. 2021;136(5):1381\u20131386."},{"issue":"6","key":"B7","series-title":"J Neurosurg","first-page":"1802","article-title":"Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures","volume":"132","author":"Jones RM","year":"2019","unstructured":"Jones RM, Kamps S, Huang Y, Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures. J Neurosurg. 2019;132(6):1802\u20131809."},{"issue":"10","key":"B8","series-title":"IEEE Trans Med Imaging","first-page":"3231","article-title":"Predicting bone marrow damage in the skull after clinical transcranial MRI-guided focused ultrasound with acoustic and thermal simulations","volume":"39","author":"McDannold N","year":"2020","unstructured":"McDannold N, White PJ, Cosgrove R. 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